Comparative study of bacteremias caused by Enterococcus spp. with and without high-level resistance to gentamicin. The Grupo Andaluz para el estudio de las Enfermedades Infecciosas.
A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.
Caballero-Granado
F J
FJ
Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Hospital de Valme, Seville, Spain. fjcaba@cica.es
Cisneros
J M
JM
Luque
R
R
Torres-Tortosa
M
M
Gamboa
F
F
Díez
F
F
Villanueva
J L
JL
Pérez-Cano
R
R
Pasquau
J
J
Merino
D
D
Menchero
A
A
Mora
D
D
López-Ruz
M A
MA
Vergara
A
A
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002404:Catheterization / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D016983:Enterococcus; D013293:Enterococcus faecalis; D005260:Female; D013502:General Surgery; D005839:Gentamicins / Q000627:therapeutic use*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010288:Parenteral Nutrition / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000382:microbiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D005839:Gentamicins